Depending on the clinical situation, the tip of the FICC can be placed in the inferior vena cava (and in this case it can be used only for infusion and blood sampling) or in the right atrium (and in this case it can also be used for hemodynamic monitoring). In the adult patient, this last option should be considered mainly in bedridden patients (for example in intensive care).
The tunneling can be upwards (with an exit site in the iliac fossa or at the side) or downwards (exit site in the distal third of the thigh, above the knee). This second type of tunneling is preferable in bedridden patients (for example, in intensive care). Beyond the presence of an upper caval obstruction, a tunneled FICC towards the knee can also be useful in non-collaborating elderly patients with cognitive deficit, in order to make the accidental displacement of the device more difficult.
The placement of tunneled FICCs requires the use of catheters long enough to cover the planned intravascular and extravascular distances, but also catheters that can be inserted with the modified Seldinger technique (which makes tunneling technically easier): in practice, we will use as FICC the catheters commonly marketed as PICCs, with obvious preference for power injectable catheters, in latest-generation polyurethane, non-valved, open-ended.